Assessing Implementation Climate and Readiness for the Thrive Intervention in School Settings: A Mixed Methods Study

Background and Purpose: Schools are increasingly recognized as critical settings for delivering mental health interventions, especially those that address child behavioral challenges and support child social-emotional development. Successful implementation of school-based programs like THRIVE—a parent-child interaction therapy—is likely influenced by the organizational context and school readiness for change. Implementation climate, which reflects how supportive a school is of adopting evidence-based practices (EBPs), is essential in whether THRIVE will be effectively implemented and integrated into the school environment. This mixed methods study, part of a Type 2 hybrid implementation-effectiveness RCT, aimed to explore baseline contextual factors likely to influence the implementation of THRIVE in school settings.

Methods: Using a convergent mixed methods design, we investigated the climate of schools implementing THRIVE. Twenty-five interventionists were recruited from five school districts in the St. Louis area. Most interventionists were school social workers, counselors, and parent engagement coordinators. The research team conducted individual qualitative interviews guided by the Consolidated Framework for Implementation Research to explore factors influencing THRIVE implementation. Deductive thematic analysis was conducted using Dedoose. Quantitative data were collected from the same group of participants using the School Implementation Climate Scale (SICS) and Organizational Readiness for Change (ORC) to measure organizational factors affecting THRIVE implementation. Quantitative data were analyzed using Stata. Major themes and descriptive statistics were reported. Qualitative and quantitative results were integrated through a systematic comparison of the findings to identify convergence and divergence.

Results: The overall SICS score averaged 3.27 (SD=0.66), indicating a moderately positive implementation climate. On average, participating schools presented a strong focus on EBP (M=3.93, SD=0.57) and high availability of training and resources for EBP (M=3.96, SD=0.82) while providing limited incentives for EBP usage (M=2.09, SD=0.93). Furthermore, the average ORC score was 3.79 (SD=0.42), suggesting moderate organizational readiness for change. Within the Organizational Climate subscale, ‘mission’ (M=3.72, SD=0.66), ‘autonomy’ (M=3.71, SD =0.54), and ‘cohesion’ (M=3.66, SD=0.65) scored relatively higher than ‘communication’ (M=3.36, SD=0.73), suggesting a collaborative and supportive working environment with shared values but insufficient communication. Qualitative data from individual interviews supported most of the quantitative findings. Many school interventionists reported a supportive work environment (n=18) with close working relationships (n=22). Only a few participants mentioned resources for implementation provided by the school (n=9). Most interventionists believed that the intervention aligns with their school’s values and will meet the needs of children in their schools (n=24). Although barriers (n=24) such as time conflicts, stigma, and socioeconomic hardships exist, interventionists appeared optimistic.

Conclusions and Implications: This study found a moderately positive implementation climate and organizational readiness for change in schools adopting the THRIVE intervention, characterized by strong support for EBPs and collaborative work culture. However, limited incentives, communication challenges, and resource constraints may hinder successful implementation. While a positive work culture and shared values were present, lower communication scores indicate a need to enhance communication systems The divergence between strong support for EBPs and the lack of resources suggests that implementation strategies must be tailored and flexible to promote buy-in and address structural barriers.